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Intensive Care Med. 2007 Dec;33(12):2093-100. Epub 2007 Oct 11.

Strict versus moderate glucose control after resuscitation from ventricular fibrillation.

Author information

1
Helsinki University Hospital, Intensive Care Units, Jorvi Hospital, Turuntie 150, 02740 Espoo, Finland. tuomas.oksanen@hus.fi

Abstract

OBJECTIVE:

Elevated blood glucose is associated with poor outcome in patients resuscitated from out-of-hospital cardiac arrest (OHCA). Our aim was to determine whether strict glucose control with intensive insulin treatment improves outcome of OHCA patients.

DESIGN:

A randomized, controlled trial.

SETTING:

Two university hospital intensive care units.

PATIENTS:

Ninety patients resuscitated from OHCA with ventricular fibrillation detected as the initial rhythm were treated with therapeutic hypothermia.

INTERVENTIONS:

Patients were randomized into two treatment groups: a strict glucose control group (SGC group), with a blood glucose target of 4-6 mmol/l, or a moderate glucose control group (MGC group), with a blood glucose target of 6-8 mmol/l. Both groups were treated with insulin infusion for 48 h, because a control group with no treatment was considered unethical.

MEASUREMENTS AND RESULTS:

Baseline data were similar in both groups. In the SGC group 71% of the glucose measurements were within the target range compared with 41% in the MGC group. Median glucose was 5.0 mmol/l in the SGC group and 6.4 mmol/l in the MGC group. The occurrence of moderate hypoglycemic episodes was 18% in the SGC group and 2% in the MGC group (p = 0.008). No episodes of severe hypoglycemia occurred. Mortality by day 30 was 33% in the SGC group and 35% in the MGC group (p = 0.846); the difference was 2% (95% CI -18% to +22%).

CONCLUSIONS:

We found no additional survival benefit from strict glucose control compared with moderate glucose control with a target between 6 and 8 mmol/l in OHCA patients.

PMID:
17928994
DOI:
10.1007/s00134-007-0876-8
[Indexed for MEDLINE]

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